Blood clots with AIHA

[admin]

Hi Meghan

I am really sorry to hear poor Gabby has this disease – the treatment your vets are giving looks superb & they are covering everything very well. As Brigitte says, they must suspect an infection of some kind if she is on doxycycline – that is the best antibiotic for killing off tick diseases & such things. Vally & Brigitte have already given you some brilliant advice & I couldn’t agree with them more. Please try & stay positive for Gabby – vets always tell you the bad side because they have to point out the worst scenario. When you go to see her, try & be as happy as you can – I know how difficult this is. I never cried in front of Worzel – I just went & sobbed my heart out in the garden where he couldn’t see or hear me. The rest of the time, I was completely determined to beat this damn thing – I believe our emotions & feelings rub off on our dogs – they are psychic for sure!

Triggers are many – I personally have always used Frontline Plus (Combo here in France) because of the millions of ticks we have around here. I’ve not heard of a case triggered by that particular treatment, but I have heard about cases triggered by vaccinations, certain heartworm medications, certain drugs & many tick diseases. My dog Worzel had ehrlichiosis (unbeknown to us – he may have had it for some time, even years) & then he was vaccinated, despite my saying he was under the weather. I could kick myself of course. The combination of the two gave him bone marrow failure because his immune system went right up the creek. At the end of the day, some people never find out exactly what triggered this in their dog or cat – and it’s no-ones fault that this happens, so you must never, ever blame yourself.

Regarding the abnormal clotting, this is very common with the disease & having a transfusion exacerbates the risk too. The treatment looks excellent & I would imagine they won’t let Gabby come home until those clots are starting to disperse. I also imagine you will have to continue with the heparin injections if you take her home – are you OK with that? I can help you with how to do that if you need advice – it is normally given subcutaneously & needs a “sideways” technique – you’ll soon catch on! There is no real “time” that anyone can give you for this to happen – in humans, some people’s clots disperse quicker than others, so you have to be patient & careful. Sometimes changing the anti-clotting medication is necessary if the clots are not responding – just a matter of watching what’s happening – is she having regular ultrasounds?

I personally like heparin treatment – it is commonly used successfully for IMHA dogs in many studies, for example Cornell University Vet Hospital. It is a standard treatment over here for people who have knee/hip replacements (6 weeks course of injections) & is often use for clot dispersal – good stuff. For clot dispersal, it would only be stopped when the clots have gone, then you continue with aspirin or clopidogrel to prevent further clots from forming. Once Gabby’s immune system is stabilised with the IMHA drug treatment, the clotting risk will become less & less – let’s hope that happens very soon, fingers crossed. Her PCV is already improving & that is great news.

Please feel free to send us anything in the way of test results & ask us anything you want to – I had a million questions when Worzel was first diagnosed & it’s hard to get your head around everything. Let us know how things are going as often as you can – we will all be thinking about you.

Sending loads of love & a big hug for you – and a very gentle hug & a kiss for Gabby
Sheena, Worzel (diagnosed Dec 2012) & his friend Ollie xxxxx

[Meghan]

Thanks again everyone! I am going to get gabby this afternoon!!!
She said she is staying stable at a pcv of about 25. The bad news is that the clots are still there, they did an ultrasound and I guess her blood is still sticky? I asked for blood work to be given to me when I get there. She said hopefully her blood can keep circulating around the clots until her body fights off the aiha. But she didn’t think the heparin was helping with the clots, so to just continue on the plavix at home along with the steroids and antibiotics and gi protection. I’m wondering if I should question her about the heparin. Would it be wise to keep giving her heparin injections for a while? She started them Monday, so was on them for 3 days.

[admin]

Meghan,
I can not give you any advice on the heparin, that would be Sheena’s specialty:) All I want to say is I am thrilled Gabby is coming home where she belongs! You will see that she will make great progress once she is in her familiar environment. Make sure to take it easy. She will need lots of rest to heal. She will probably eat pretty good, the steroids make her hungry like crazy. She will also be thirsty like crazy so have clean water available for her all the time. Don’t be alarmed if there are some accidents, what goes in must come out:) But if you take her out lots that should not be a problem.
I am so happy for you that Gabby will be home soon, best wishes,
Brigitte

[admin]

Hi Meghan

Oh, I’m so pleased you can bring her home!!!! Great! – a PCV of 25 is pretty good in these early days. Gabby will be much more comfy back with you & you can really pamper her. As Brigitte says, she’ll be very tired, drinking lots of water (they need to) & pee-peeing a lot too. If you are concerned about anything, just tell us.

Please don’t worry about the heparin being stopped. I am sure your vet is keeping a good eye on Gabby’s clotting problems – if they say just Plavix, that is absolutely fine – it would be unusual to have to inject heparin yourself at home – they probably wouldn’t want you to take her home if that is the case anyway.

There are several blood tests (blood smears to look for spherocytes or other abnormal blood cells, prothrombin time, partial thromboplastin time etc) that they would do to determine which & how much anti-clotting medication is needed & I think you have to trust them to give you the right advice. Most of the dogs on here only need aspirin or plavix (clopidogrel) after the initial crisis – I can only remember one person having to inject at home off hand. Incidentally, I have a good friend who has a blood clot in his neck (really scary) – he’s only on his early 40’s & a very fit guy – we have been really worried – he was on heparin for the first 4 days, but came home & he’s only on plavix now, so it seems to be the “norm”. It should certainly prevent further clots, which is exactly what you want.

(Thanks Brigitte for the lovely compliment, you kind lady, but I’m not really an expert on this – still learning – clotting is a very complicated subject with so many factors being involved – I only have a “reasonable” overview).

Please tell us how she is when you get her home – thinking about you
Love Sheena xoxox

[Meghan]

I sent in the info on the urgent advice, but can’t get it to attach here. I got to pick gabby up this afternoon!! She was so happy to come home!!!! Her pcv is still stable but the main concern is her clotting.

[Patrice]

Meghan,
So good that Gabby is coming home! She must be so happy to be with you…

Your test results did attach to your urgent advice request. Looking it over I see that the vet is noting that there may have been some problems with this blood sample.

One possible problem that is mentioned is lipemia. This is fat that was in the blood from a recent meal. It is usually a good idea to fast 8-10 hours before the test to avoid this. The fat can make the blood sample difficult to read. Think of what oil floating on water looks like, for instance in a puddle of water. It can refract light changing the thing underneath the oil

Another thing that was mentioned was that there could be sample hemolysis. This means that the blood could have been damaged at any time while it was being handled. For instance if a dog is severely dehydrated the blood draw can be difficult to get. Cells can bump around against each other and become damaged. This can also happen if the tech is not careful with the sample tube, red blood cells will break. If the sample sat around too long before they worked with it, then there could be “artifacts” or abnormalities in the sample.

What to do? At this point the vet should take another sample. Evaluating Gabby’s condition with this sample in mind might lead to incorrect conclusions about her condition.

I do note that the glucose is a bit high. Again this could be incorrect, but it can also be a side effect of the prednisone. Sometimes, not very often, high dose prednisone can create a temporary diabetic condition. In those cases it is often a good idea to reduce the prednisone as quickly as is practicable. Your vet should be thinking along these lines.
my best
patrice

[admin]

Hi Meghan

We received the blood tests etc just fine – the moderators get them via e-mail – so thank you for doing that. Gabby has really been through a rough time & I see she has a severe abnormal clotting risk called auto-agglutination (sticky red blood cells that can cause clots) – a good reason to continue with the Plavix to prevent further clots from forming. You can see & read about auto-agglutination here:
https://www.secondchanceaihadogs.com/AIHA_Terms/agglutination/
Plavix is often used for this – good job, vets.
Her platelets are a bit low (not worryingly so) so there is no clotting risk with them at all – low platelets are often seen at the beginning of the disease too.

I am not going to tell you this isn’t serious- I know you know it is – but Gabby can get better -her treatment has been excellent – keep really positive, Meghan. The drugs will take a little time time to work & slow down the auto-agglutination – be patient – keeping her very calm & quiet is the best thing for now. I see your vets have fully explained what to look out for – it’s all very good advice. Again, if you are worried about anything, post a note on here – one of us is usually awake as we are world-wide.

Freezing cyclosporine is not advisable – I will explain another time, but please don’t do that as it may affect the potency of the drug. I know some vets advise this, but after lengthy research & discussion, this is NOT a good idea. Some dogs get nausea at the high initial loading dose & this will subside when the dose is lowered. And you have the anti-nausea meds too if necessary.

Vally will always do you a medication chart if you like – she’s brilliant at that & it’s horrible trying to work out what to give when & what with food, without food & gaps in between right! For now, make sure you don’t give the tummy protectant within an hour of any of the other drugs as it can stop correct absorption. I would also have liked to see sucralfate on the list – a 1mg dose last thing at night at least. Would you mind asking if they could add that please? When Worzel was on doxycycline, it was the ONLY thing that stopped his tummy ache. It must be given 2 hrs after any other drugs. Also, her liver is already being affected (we’ve all had this with our dogs too – again it’s the drugs), so adding Denamarin as soon as possible will help reduce the problem. This is also important – you can get it from Amazon if necessary.

The high WBC I guess is what your vets are thinking is caused by infection – let’s see how things go with the antibiotics. Sometimes when the blood cells are all “to pot” with this disease & it’s hard to get a good sample, the automatic counting machines are not that accurate – good to see they are looking at blood smears too. I can’t see anything noted there except the auto-agglutination though.

I’d like to have a chat with Patrice about Gabby’s blood results too – she has more experience than I do & may well spot something I haven’t. I hope I’ve covered everything urgent for now – please give Gabby a very gentle cuddle from her new Auntie Sheena – I hope she’ll soon be on the mend.

Loads of love, Sheena xxxxx

[Meghan]

Hello all, thanks for the advice on Gabby! I’m sitting here on the couch next to her now, so happy!!
Vally, I would love a medication chart! I’m sitting here trying to work on it and it is a little difficult. :)
Patrice, that’s interesting about the blood test possibly not being accurate. It is kind of frustrating considering we just paid so much money! I will ask about the prednisone with the high glucose, good advice.
Sheena, thanks for the info on the cyclosporin. I came home and put it in the freezer, then took it out shortly after to give to her and was reading that ideal storage is 59-77f degrees so I took it out. I thought that was odd and didn’t want to affect the drug.
I will ask about the sucralfate also. I did ask the dr about a liver protector today, she said she didn’t think she needed it right now because she’s on so many drugs already and wants happening to her liver is from the clotting? Does that make sense?